AB1430 COMPARISON OF COGNITIVE ABILITY ACROSS THE IMMUNE MEDIATED INFLAMMATORY DISEASES: SYSTEMATIC REVIEW AND META-REGRESSION
Authors: J. Gwinnutt, T. Toyoda, M. Barraclough, S. Verstappen, D. Montaldi, M. Hornberger, A. Macgregor
Journal: Annals of the Rheumatic Diseases (2022)

Background Age strongly influences cognitive ability. Previous studies have tried to compare the cognitive ability of people with different immune mediated inflammatory diseases (IMIDS: systemic lupus erythematosus [SLE], rheumatoid arthritis [RA], axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], psoriasis [PsO]) in age-matched analyses. However, given the varying age of onset of these conditions, within direct age-matched comparisons one of the disease groups is necessarily older/younger than typical. Objectives (i) To perform a systematic review of the cognitive ability of people with IMIDs compared with age-matched controls, and (ii) use meta-regression to indirectly compare the cognitive ability of people with different IMIDs. Methods A search strategy was implemented in the Medline, Embase and PsychInfo databases on 29.5.2021. Identified studies were screened by two reviewers, selecting observational studies comparing the cognitive ability of people with an IMID against healthy controls. This abstract only includes studies reporting overall cognition scores, memory scores and attention scores. The standardised mean differences (SMDs) of the cognitive assessments between people with IMIDs and controls were pooled using random-effects meta-analysis, stratified by IMID. The IMIDs were compared using meta-regression, to identify the IMID with the greatest impairment in cognitive ability compared with healthy people of a similar age (inclusion cut-off: ≥5 studies). Results In total, 62 studies (SLE: 37, RA: 18, axSpA: 1, PsA: 2, PsO: 4) were included in the meta-analyses. People with IMIDs had moderate impairments in overall cognition, memory and attention compared with controls (Table 1), with similar results seen when limiting analyses to studies which included age-matched controls (N=48 studies). People with SLE and RA had similar levels of impairment compared with controls of comparable age in terms of overall cognition (coef: -0.12 (95% CI -0.42, 0.19) and attention (coef: -0.35 (95% CI -0.73, 0.04)). Other IMIDs and cognition dimensions were not included in the meta-regression analysis due to lack of studies. Table 1. Results of meta-analyses Standardised mean difference (95% Confidence Interval) [N studies] Systemic lupus erythematosus Rheumatoid arthritis Axial spondyloarthritis Psoriatic arthritis Psoriasis Overall cognition All -0.55 (-0.70. -0.39) [18] -0.59 (-0.82, -0.35) [13] -0.66 (-1.11, -0.21) [1] -0.50 (-0.78, -0.21) [2] -0.51 (-1.09, 0.07) [3] Age-matched -0.55 (-0.72, -0.38) [14] -0.66 (-0.92, -0.41) [11] -0.66 (-0.11, -0.21) [1] -0.61 (-1.08, -0.14) [1] -0.77 (-1.39, -0.16) [2] Attention All -0.51 (-0.63, -0.38) [27] -0.79 (-1.10, -0.47) [9] -0.58 (-1.03, -0.13) [1] - -0.14 (-0.42, 0.14) [2] Age-matched -0.51 (-0.67, -0.36) [21] -0.87 (-1.35, -0.39) [6] -0.58 (-1.03, -0.14) [1] - -0.36 (-0.75, 0.04) [1] Verbal memory (immediate ) All -0.59 (-0.79, -0.38) [19] -1.00 (-1.47, -0.53) [7] - - -0.52 (-1.05, 0.02) [3] Age-matched -0.61 (-0.90, -0.32) [12] -1.42 (-1.73, -1.12) [4] - - -0.72 (-1.42, -0.02) [2] Verbal memory (delayed ) All -0.44 (-0.57, -0.31) [18] -0.93 (-1.48, -0.38) [5] -0.23 (-0.67, 0.21) [1] - -0.52 (-1.52, 0.49) [2] Age-matched -0.39 (-0.56, -0.21) [12] -1.40 (-1.76, -1.03) [3] -0.23 (-0.67, 0.21) [1] - -1.05 (-1.47, -0.63) [1] Non-Verbal memory (immediate ) All -0.41 (-0.57, -0.25) [15] -0.32 (-1.23, 0.58) [1] -0.21 (-0.62, 0.23) [1] - - Age-matched -0.34 (-0.52, -0.16) [10] - -0.21 (-0.62, 0.23) [1] - - Non-Verbal memory (delayed ) All -0.45 (-0.63, -0.27) [16] -0.41 (-0.91, 0.08) [1] -0.14 (-0.58, 0.30) [1] - - Age-matched -0.46 (-0.75, -0.17) [10] -0.41 (-0.91, 0.08) [1] -0.14 (-0.58, 0.30) [1] - - Conclusion People with IMIDs have significant impairments in terms of overall cognition, memory and attention. Whilst this indirect analysis shows that people with SLE and RA have a similar magnitude of impairment compared with healthy controls of a similar age, a number of factors could be influencing this finding (e.g. selection bias, demographic differences). Disclosure of Interests None declared